The Healthcare System

Juggling Financial Expenses As a caregiver, you will likely find yourself involved in financial matters. Even if the patient is not your spouse or partner, you may find that you want or have to contribute your own money to the care of the patient. This can be an expensive commitment. Medical bills and prescriptions can become very costly, leaving you wondering how you and/or the patient will make ends meet. It is important not to panic. There are ways to better manage money, receive financial assistance, and get the most coverage possible from the patient's health care benefits. Budgeting Money The best way to get a handle on the patient's finances is to work out a budget. Start by writing down all regular monthly expenses, including: rent or mortgage payments phone and utility bills transportation (car payments, gas, public transportation, tolls, parking) insurance premiums food clothing child-care or elder-care costs medical expenses (prescriptions, medical supplies, other medical costs) monthly loan payments taxes tuition legal and accounting fees other household expenses any other monthly expenses Once you have written down all of these expenses, add up the total, deduct this from your monthly income, and review the amount left. If you find that cash is low, you may want to try some of the following options: Prioritize bills. First pay for essential expenses, such as food, shelter, and medication. Postpone payment of larger medical or credit card bills. Ask your utility companies (gas, electric, phone) about assistance programs they may offer to help people who cannot meet their payments. Find out whether the pharmaceutical companies that produce your family member's medication offer prescription medicine assistance programs. Make sure your family member is receiving his/her Social Security benefits (Retirement, Disability, Survivor, Supplemental Security Income (SSI), or Black Lung benefits). Look into dependent-care tax exemptions or credits for family caregivers. See if there are family caregiver assistance programs offered at your local agencies on aging. Consider other ways to bring in income, such as working from home, asking family members for a loan, or requesting help with bill payment from other household members. Here are some agencies that can assist you in obtaining these and other financial options. Handling Health Insurance Receiving huge medical bills from the hospital or doctor can cause a lot of anxiety. Reading the bill, figuring out how it will be paid, and determining which services should be covered by the patient's insurance company are some of the problems you may face. Here are things you can do to help minimize the stress associated with these activities. Read the insurance policy thoroughly There are certain services that insurance plans will and will not pay for. It is important for you to know what is covered in order to follow procedures that will maximize coverage, such as getting a referral before seeing a doctor. It will also help to ensure that the patient is getting all benefits to which he/she is entitled. If you have trouble understanding the insurance contract, ask someone with more experience to help you or call the insurance company with specific questions about what is covered. Check medical bills It is not uncommon to be billed incorrectly by the hospital or doctor. Look over each bill carefully and make sure that the patient is not being billed for services that were not received. If you find charges that are doubtful, call the billing department of the hospital or doctor's office for clarification. Don't panic about big medical bills If a huge medical bill arrives asking for payment of the "amount due," don't panic. Many times, bills are sent out before payments are received from the insurance company.  If you are concerned, you can call the billing office at the hospital and ask if there are any insurance claims pending on the patient's account. If so, you can wait until all payments are received from the insurer before paying the bill. Submit claims properly Some doctor's offices or insurance companies require the insured person to submit claims, rather than the billing office. If you have to fill out claim forms and submit them, be sure to: Submit a claim as soon as you receive a medical bill. Double check your work to make sure the information on the claim form is correct. Make sure to attach all supporting documents (e.g. copies of bills, receipts). Keep photocopies of bills, submitted claims, payment stubs from the insurance company, explanations of benefits, and insurance company findings. Call the insurance company if you have any questions or are unsure about anything to do with making a claim. Keep notes on your phone conversations, including the name of the insurance agent, the date of the call, and the information you were given. Be persistent Claims may be denied for any number of reasons, including mistakes on claim forms, missing documents, or varying practices of claims adjusters. If the patient's claim is denied, you can always send it again and try for a different result. It may also help to ask the patient's doctor to write a letter to the insurance company, explaining the need for certain procedures. Sometimes, this will lead the insurance company to re-examine a claim. If you have tried these suggestions, and are still not happy with the result, you can ask the insurance company about their procedure for resolving disputed claims. You can also contact a lawyer or your state insurance regulator. (Adapted from McFarlane & Bashe, 1998)